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Usefulness of preoperative drip infusion cholangiography with computed tomography for predicting surgical difficulty during laparoscopic cholecystectomy
Author(s) -
Nakazawa Akiko,
Akamatsu Nobuhisa,
Miyata Yoichi,
Komagome Masahiko,
Maki Akira,
Arita Junichi,
Ishizawa Takeaki,
Kaneko Junichi,
Beck Yoshifumi,
Hasegawa Kiyoshi
Publication year - 2020
Publication title -
journal of hepato‐biliary‐pancreatic sciences
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.63
H-Index - 60
eISSN - 1868-6982
pISSN - 1868-6974
DOI - 10.1002/jhbp.718
Subject(s) - medicine , cholangiography , laparoscopic cholecystectomy , cholecystectomy , computed tomography , bile duct , radiology , nuclear medicine , gallbladder , tomography , body mass index , surgery
Background Drip infusion cholangiography with computed tomography (DIC‐CT) is a major preoperative modality used for patients undergoing laparoscopic cholecystectomy (LC). Methods This study included 218 patients for whom preoperative DIC‐CT images were obtained prior to undergoing LC. The association between gallbladder (GB) opacification in DIC‐CT and the operative time was assessed. Results The GB opacification on the DIC‐CT images was classified as follows: Grade 0, homogeneous opacification; Grade 1, heterogeneous opacification; Grade 2, only cystic duct can be identified; and Grade 3, no opacification. Images obtained for the 218 patients showed 41 (18.8%) with Grade 0, 91 (41.7%) with Grade 1, 54 (24.8%) with Grade 2, and 32 (14.7%) with Grade 3. The operative time and intraoperative blood loss were significantly longer and larger, respectively, in cases classified as Grade 2 or 3 (GB negative) compared with cases classified as Grade 0 or 1 (GB positive). We created an LC difficulty score based on the following variables that were significant independent predictors of increased operative time: GB negativity in DIC‐CT ( P = .002, 2 points), GB wall thickness ( P = .002, 2 points), body mass index ( P = .015, 1 point), preoperative alkaline phosphatase value ( P = .018, 1 point), and preoperative C‐reactive protein value ( P = .04, 1 point). The LC difficulty score (Grade A, score 0‐2; Grade B, score 3‐5; and Grade C, score 6‐7) was significantly associated with a prolonged operative time. Conclusion Drip infusion cholangiography with computed tomography is useful for predicting the surgical difficulty of LC.